Summary
Overview
Work History
Education
Skills
Timeline
Generic

Abhinesh Kumar Maurya

Ahmedabad

Summary

I am eager to align myself with a prestigious organization where I can apply my expertise and dedication to drive success. My goal is to thrive in an innovative and competitive environment that fosters professional growth while allowing me to unlock my full potential. I am committed to being a key player in challenging projects, utilizing my skills to contribute positively to the organization’s objectives.

Overview

12
12
years of professional experience

Work History

Quality Team Lead

EMP Claims
Ahmedabad
06.2024 - Current
  • Led a high-performing team of 20 TCs and auditors, championing excellence in quality management.
  • Oversaw comprehensive client quality reports, ensuring optimal practice health and adherence to standards.
  • Developed and maintained SOPs and DOUs to guarantee seamless client transitions.
  • Generated and analyzed quality reports daily, weekly, and monthly to fuel strategic decision-making.
  • Optimized resource allocation to drive peak performance and maximize utilization.
  • Validated AR allocation files with production data to swiftly address operational challenges.
  • Collaborated with cross-functional teams to enhance coding, billing, and posting processes, boosting efficiency.
  • Provided actionable audit insights daily, elevating quality standards across the organization.
  • Monitored pending rework status, and maintained a dynamic call monitoring dashboard for enhanced performance tracking.
  • Conducted KRA and KPI evaluations for team scorecards to drive accountability and success.
  • Prepared a monthly audit bulletin for departmental awareness and continuous improvement.
  • Maintained critical audit documentation, including Audit SOPs, Audit Coverage Trackers, and various performance trackers, to ensure operational excellence.

QAL (Quality Assurance Leader)

Eclat Healthcare Solutions
Hyderabad
02.2023 - 05.2024
  • Led a high-performing team of 25 Quality Assurance Analysts, driving operational excellence through effective collaboration and communication.
  • Developed and implemented comprehensive DOU and SOP documents for seamless transitions with new clients.
  • Prioritized and managed client escalations and tasks, ensuring prompt resolution and satisfaction.
  • Oversaw multiple quality processes, aligning them with client requirements to enhance service delivery.
  • Prepared insightful client reports (DPU/DPO) on a daily, weekly, and monthly basis to track performance metrics.
  • Compiled detailed MBR/QBR presentations for all clients, showcasing progress, and future goals.
  • Monitored the QA audit process, ensuring authenticity, and reliability in reporting.
  • Tracked QA productivity and attendance to maintain high standards of performance.
  • Ensured QA teams adhered to client instructions, fostering alignment, and accountability.
  • Led client ATA calls (Audit the Auditor) to present root cause analysis (RCA), and drive continuous improvement.
  • Proposed strategic audit sampling is based on comprehensive internal and external performance evaluations.
  • Supervised the timely execution of QA tasks, ensuring adherence to deadlines and quality standards.
  • Provided RCA and Plans of Action (POA) to clients as needed, reinforcing transparency and trust.
  • Developed BQM lists and audit patterns to streamline processes and enhance quality assessments.
  • Delivered weekly, monthly, and quarterly quality summaries to management, highlighting key insights and recommendations.
  • Conducted targeted evaluations of bottom performers to identify training needs, and improve overall team quality.
  • Initiated action plans to elevate individual and process quality, driving continuous improvement across the board.

QA & Process Trainer AR

GeBBS Healthcare Solution Pvt. Ltd.
Mumbai/Hyderabad
03.2017 - 02.2023
  • Led and managed a team of 12 associates, driving high-performance outcomes through effective work allocation and daily huddles.
  • Delivered comprehensive training programs to new hires, fostering skill development, and team cohesion.
  • Analyzed inventory and team production metrics to optimize operational efficiency and enhance quality outcomes.
  • Monitored team performance across production, quality, and behavior, ensuring alignment with organizational standards.
  • Conducted thorough audits and managed audit file allocation to ensure compliance and excellence.
  • Implemented call monitoring and SBS audits to maintain high standards of service quality.
  • Oversaw the preparation, action, and analysis of Documents of Understanding (DOU) for continuous improvement.
  • Managed and updated operational trackers to ensure accurate performance evaluations.
  • Facilitated client communication through daily, weekly, and calibration calls to ensure alignment and satisfaction.
  • Produced detailed reports, including audit reports, dashboards, and quality/client decks, to drive informed decision-making.

RCM Specialist

eCW
Mumbai
04.2016 - 02.2017
  • Conducted proactive follow-ups on insurance claims and denial statuses to ensure timely resolutions.
  • Developed and submitted comprehensive appeals through various channels, including portals, fax, and mail.
  • Maintained optimal practice health by strategically managing aging and priority claims.

Sr. Associate Operations

Inventurus Knowledge Solutions Pvt. Ltd
Mumbai/Hyderabad
04.2013 - 03.2016
  • Accounts Receivables and Denial Management.
  • Insurance correspondence.
  • Charge Entry.
  • Constantly updating and coaching the new joiners on new updates from the clients to the team.
  • Supports the floor and has conducted training to streamline the process.
  • Billing claims to insurance with the addition of a modifier, posting payments in the system, and billing the patient through the system.
  • Process medical benefits claims, accurately verify their information, and be able to determine their plan eligibility for any claims.
  • Knowledge of denial management.
  • Providing floor support and focusing on productivity.
  • Quality and overall project requirements.
  • Responsible for clearing the OJT phase for new hires and also conducting internal audits of team members.
  • Resolving escalation and clinic responses from the West team.
  • Supervising, mentoring, and supporting staff within the team.
  • Followed up on insurance denials and appeals for unpaid claims.
  • Claims, appeal submission through electronic mail, or fax.
  • Generate production reports and make sure to achieve a daily team target.
  • Managed accounts receivables and denial management, ensuring accurate insurance correspondence and charge entry.

Education

Bachelor of Arts -

VBS Purvanchal University
Jaunpur
01-2008

Skills

  • Client escalations and satisfaction
  • Reporting with 7 QC tools
  • RCM and Denial Training
  • SOP/DOU Creation
  • Maintaining the Process Guide
  • Leading client calls
  • WBR, MBR, QBR
  • Team Management
  • Resource utilization and optimization
  • Stakeholder management
  • Monitoring KPIs
  • Quality metrics
  • Innovation mindset
  • Calibration management
  • Quality management
  • Continuous quality improvement
  • CAPA management
  • Performance evaluations
  • Quality management systems

Timeline

Quality Team Lead

EMP Claims
06.2024 - Current

QAL (Quality Assurance Leader)

Eclat Healthcare Solutions
02.2023 - 05.2024

QA & Process Trainer AR

GeBBS Healthcare Solution Pvt. Ltd.
03.2017 - 02.2023

RCM Specialist

eCW
04.2016 - 02.2017

Sr. Associate Operations

Inventurus Knowledge Solutions Pvt. Ltd
04.2013 - 03.2016

Bachelor of Arts -

VBS Purvanchal University

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Abhinesh Kumar Maurya